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Blam, Oren; Vaccaro, Alexander R.; Vanichkachorn, Jed S.; Albert, Todd J.; Hilibrand, Alan S.; Minnich, John M.; Murphey, Sheila A.

doi:10.1097/00007632-200307010-00022

Cited by 22 publications

(33 citation statements)

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“…The postoperative stay of 2.92 days is 31.7 % shorter than that of patients in the SD pathway and between 33 and 65 % shorter than published averages in the North American literature [2–8]. This decrease in hospital stay has many potential benefits, including lessening the potential exposure to nosocomial infection [14–18], a quicker transition to the home setting for patients and for parents with multiple children, and earlier return to work for the parents. Given the retrospective nature of this study, it is difficult to say what aspect of the pathway provides the biggest impact with regards to early discharge; however, the establishment of an expectation for discharge on the second hospital day is crucial to the pathway’s success [19–24].…”

Section: Discussionmentioning

confidence: 99%

Clinical and economic implications of early discharge following posterior spinal fusion for adolescent idiopathic scoliosis

Fletcher

Shourbaji

Mitchell

et al. 2014

Journal of Children's Orthopaedics

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ObjectiveTo evaluate the clinical and economic impact of a novel postoperative pathway following posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS).MethodsPatient charts were reviewed for demographic data and to determine length of surgery, implant density, use of osteotomies, estimated blood loss, American Society of Anesthesiologists (ASA) score, length of hospital stay, and any subsequent complications. Hospital charges were divided by charge code to evaluate potential savings.ResultsTwo hundred and seventy-nine of 365 patients (76.4 %) treated with PSF carried a diagnosis of AIS and had completed 6 months of clinical and radiologic follow-up, a period of time deemed adequate to assess early complications. There was no difference between groups in age at surgery, sex, number of levels fused, or length of follow-up. Patients managed under the accelerated discharge (AD) pathway averaged 1.36 (31.7 %) fewer days of inpatient stay. Operative time was associated with a shorter length of stay. There was no difference in complications between groups. Hospital charges for room and board were significantly less in the AD group ($1.885 vs. $2,779, p < 0.001).ConclusionsA pathway aimed to expedite discharge following PSF for AIS decreased hospital stay by nearly one-third without any increase in early complication rate. A small but significant decrease in hospital charges was seen following early discharge. Early discharge following PSF for AIS may be achieved without increased risk of complications, while providing a small cost savings.Electronic supplementary materialThe online version of this article (doi:10.1007/s11832-014-0587-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Clinical and economic implications of early discharge following posterior spinal fusion for adolescent idiopathic scoliosis

Fletcher

Shourbaji

Mitchell

et al. 2014

Journal of Children's Orthopaedics

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“…[910131517222627284147567079888996104120150154] Although the type of spinal surgery most significantly correlates with infection rates, there are multiple other preoperative, intraoperative, or postoperative factors that also contribute to the risk of infection following spinal fusions; age, male sex, steroid therapy, diabetes, smoking, American Society of Anesthesiology (ASA) score, obesity, malnutrition, presence of comorbidities, and previous surgery [Table 1]. [523384145707682849798122123142] …”

Section: Comprehensive Literature Review Of Instrumented Spinal Infecmentioning

confidence: 99%

Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management

Kasliwal

Tan²,

Traynelis³

2013

Surg Neurol Int

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Background:Instrumentation has become an integral component in the management of various spinal pathologies. The rate of infection varies from 2% to 20% of all instrumented spinal procedures. Every occurrence produces patient morbidity, which may adversely affect long-term outcome and increases health care costs.Methods:A comprehensive review of the literature from 1990 to 2012 was performed utilizing PubMed and several key words: Infection, spine, instrumentation, implant, management, and biofilms. Articles that provided a current review of the pathogenesis, diagnosis, prevention, and management of instrumented spinal infections over the years were reviewed.Results:There are multiple risk factors for postoperative spinal infections. Infections in the setting of instrumentation are more difficult to diagnose and treat due to biofilm. Infections may be early or delayed. C Reactive Protein (CRP) and Magnetic Resonance Imaging (MRI) are important diagnostic tools. Optimal results are obtained with surgical debridement followed by parenteral antibiotics. Removal or replacement of hardware should be considered in delayed infections.Conclusions:An improved understanding of the role of biofilm and the development of newer spinal implants has provided insight in the pathogenesis and management of infected spinal implants. This literature review highlights the mechanism, pathogenesis, prevention, and management of infection after spinal instrumentation. It is important to accurately identify and treat postoperative spinal infections. The treatment is often multimodal and prolonged.

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“…The USA National Healthcare Safety Network reported a mean SSI rate of 0.7% to 4.2% for spinal fusions and 0.7% to 2.3% for laminectomies [6]. Rates of infection are generally higher in non-elective instrumented spinal fusions for trauma, with reported rates up to 10% [7]. The increased cost of stay coupled with changes in the Centers for Medicare and Medicaid Services reimbursement practices serve as strong incentives for adopting departmental and hospital policies aimed at reducing the incidence of SSI and improving patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for surgical site infection after instrumented fixation in spine trauma

Cooper

Glenn

Martin

et al. 2016

Journal of Clinical Neuroscience

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Surgical site infection (SSI) represents a significant complication after instrumented fixation in spine changes have emphasized early fracture correction, shortened intraoperative times, early ambulation, and prompt nutritional supplementation. This retrospective study evaluates the senior author’s experience of instrumented spinal trauma SSI occurring at a single Level I trauma center over two equal and contiguous time periods, 2005–2007 (before nutritional supplementation was added to the institutional protocol) and 2008–2010 (after nutritional supplementation was added). This study assessed whether SSI varied depending on the primary surgical site and/or by the chosen approach. Lastly, the incidence of SSI among demographic and other clinical variables was evaluated. In total, 358 patients underwent an index procedure for spinal trauma correction. Fourteen patients developed a SSI requiring reoperation for an incidence of 4.0%. In assessing nutritional supplementation, the probability of infection tended to be lower in the supplemented group (3.7%) than the pre-supplement group (4.3%), but this did not reach significance. The difference in approach for the cervical spine was statistically significant (p = 0.045) with rates of infection via posterior approach at 8.1% and no infections via anterior approach. Presence of comorbidities (p = 0.03) and time to surgery >3 days (p = 0.006) were predictors of developing SSI. Benefit is shown from early surgical correction of spinal trauma patients in the reduction of postoperative SSI. Nutritional supplementation may provide a small reduction in infections in the spine trauma population.

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Abstract: Risk factors for surgical site infection in the acute trauma setting are identified. Two surgical teams may be involved without causing a higher rate of infection.

Cited by 22 publications

References 0 publications

Clinical and economic implications of early discharge following posterior spinal fusion for adolescent idiopathic scoliosis

Clinical and economic implications of early discharge following posterior spinal fusion for adolescent idiopathic scoliosis

Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management

Risk factors for surgical site infection after instrumented fixation in spine trauma

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